title: Intravenous thrombolytic therapy in patients with stroke mimics: baseline characteristics and safety profile.
abstract: BACKGROUND
  The decision to treat with intravenous (i.v.) rt-PA a patient with acute cerebral ischaemia is based on clinical and imaging criteria recorded in emergency. In such an emergency situation stroke mimics may sometimes be misdiagnosed, and lead to an erroneous prescription of rtPA. The objective of this study was to determine the baseline profile and the outcome in patients with stroke mimics who received i.v. rtPA.
  
  
  METHODS
  We analysed clinical characteristics, and outcomes in patients diagnosed at discharge as having a stroke mimic who received rtPA in the university hospitals of Lille and Belgrade.
  
  
  RESULTS
  Amongst 488 patients, seven (1.4%) were diagnosed at discharge with stroke mimics: four had somatoform disturbances, one had migraine aura, one had Bell palsy, and one had a probable Todd's palsy. Patients with stroke mimics were younger, and had milder deficits. Six were investigated by computed tomographic-scan and the only one who had an emergency magnetic resonance imaging, had no abnormality on diffusion weighted images. Five patients had a modified Rankin scale 0-1 and there was no case of intracranial bleeding.
  
  
  CONCLUSIONS
  Patients with stroke mimics have a good safety profile when treated with rt-PA. In case of doubt, physicians should not postpone thrombolysis, because its potential benefit in confirmed ischaemic stroke might be higher than the risk of complications in stroke mimics. A combined analysis of such small series of cases would be useful to have a better delineation of the clinical profile of these patients.
authors.affiliation: Department of Neurology, Univ Lille Nord de France, Lille, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.forename: V
authors.initials: V
authors.lastname: Bogosavljevic
authors.forename: D
authors.initials: D
authors.lastname: Leys
authors.forename: D
authors.initials: D
authors.lastname: Jovanovic
authors.forename: L
authors.initials: L
authors.lastname: Beslac-Bumbasirevic
authors.forename: C
authors.initials: C
authors.lastname: Lucas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy; D003951:Diagnostic Errors / Q000009:adverse effects; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects* / Q000235:genetics
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator